VECTURA INHALERS
The Vectura website states that their “combination of formulation science, device technology and inhaled development expertise has contributed to the success of 13 inhaled medicines, launched by our partners and licensees. Since launch, they have generated $11 billion in sales and in 2020 these products were used by 10 million patients worldwide .”7 The products are set out in Table 1 and Figure 1, based on the Vectura Group plc Annual Report and Accounts 2020.8 The Vectura accounts report revenue income in 2020 for Flutiform, royalty and other marketed revenues for the GSK Ellipta, Novartis Breezhaler, Hikma generic Advair programme, and Sandoz Forspiro.
Data from the NHS Business Services Authority (https://www.nhsbsa.nhs.uk/statistical-collections/prescription-cost-analysis-england/prescription-cost-analysis-england-202021) show that in 2020, English primary care spend on inhalers totalled £960.5 million. The Vectura products listed equate to £177 million - almost a fifth of total inhaler expenditure.
Fortunately, over 120 inhaled products are now licensed for the treatment of asthma and COPD in the UK, so there are likely to be several suitable alternatives for patients that healthcare professionals can prescribe, to avoid directing income to the tobacco industry if the takeover goes ahead. Some examples are set out in Table 2.
Inevitably, a change in prescribing policy will require switching some individuals to alternative preparations and different inhaler devices. It may also require a change in the inhaled drug(s) to different ones in the same class. It is important therefore, that proposed changes are performed in collaboration with each patient as a partner, using the principles of shared decision making9. Changes in inhaled therapy will require careful discussion with patients about the reasons for such a change, potential available options and their agreement to switch.
In order to ensure that asthma and COPD control is optimised, it is essential that inhaler technique is taught and checked, before an alternative is prescribed. An assessment of each patient’s inspiratory capacity to use either a dry powder inhaler or an aerosol device (pMDI, breath-actuated pMDI or soft mist inhaler) should be made to determine the most appropriate type of device to prescribe.10The use of low carbon inhaler devices may be prioritised in patients able to use dry powder or soft mist inhalers, but if not, then pMDIs should be used.
Table 1. Current approved inhaled medicines developed in partnership with Vectura